Left atrial appendage: Structure, function, and role in thromboembolism

Heart

Volumn 82, Issue 5, 1999, Pages 547-554

  Al Saady, N M ^a   Obel, O A ^a   Camm, A J ^a  

^a ST GEORGE'S UNIVERSITY OF LONDON   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ATRIAL NATRIURETIC FACTOR; WARFARIN;

BLOOD FLOW VELOCITY; CARDIOVERSION; CLINICAL TRIAL; HEART ATRIUM FIBRILLATION; HEART ATRIUM THROMBOSIS; HEART LEFT AURICLE; HUMAN; MITRAL VALVE DISEASE; PRIORITY JOURNAL; REVIEW; THROMBOEMBOLISM; TRANSESOPHAGEAL ECHOCARDIOGRAPHY;

EID: 0032723885     PISSN: 13556037     EISSN: None     Source Type: Journal    
DOI: 10.1136/hrt.82.5.547     Document Type: Review

References (72)

1. 1 Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg 1996;61:7559.
2. 2 Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 1991;22:983-8.
3. 3 Wolf PA, Dawber TR, Thomas HE, et al. Epidemiological assessment of chronic atrial fibrillation and risk of stroke: The Framingham study. Neurology 1978;28:973-7.
4. 4 Kannel W, Wolf PA. Epidemiology of atrial fibrillation. In: Falk RH, Podrid PJ, eds. Atrial fibrillation: mechanisms and management. New York: Raven Press, 1992:81-92.
5. 5 Odell JA, Blackshear JL, Davies E, et al. Thoracoscopic obliteration of the left atrial appendage: potential for stroke reduction. Ann Thorac Surg 1996;61:565-9.
6. 6 Brass LM, Krumholz HM, Scinto JM, et al. Warfarin for use among patients with atrial fibrillation. Stroke 1997;28: 2382-9.
7. 7 Sadler TW. Cardiovascular system. In: Langman J, ed. Langman's medical embryology, 6th ed. Baltimore: Williams and Wilkins, 1990:179-227.
8. 8 Ernst G, Stollberger C, Abzieher F, et al. Morphology of the left atrial appendage. Anat Rec 1995;242:553-61.
9. 9 Mugge A, Kunn H, Nikutta P, et al. Assessment of left atrial appendage function by biplane transesophageal echocardiography in patients with non rheumatic atrial fibrillation: identification of a subgroup of patients at increased embolic risk. J Am Coll Cardiol 1994;23:599 607.
10. 10 Pollick C, Taylor D. Assessment of left atrial appendage function by transesophageal echocardiography. Implications for the development of thrombus. Circulation 1991;84:223-31.
11. 11 Lannigan RA, Zaki SA, Ultrastructure of myocardium of the atrial appendage. Br Heart J 1966;28:796 807.
12. 12 James TN. Small arteries of the heart. Circulation 1977;56: 2-14.
13. 13 Bishop VS, Malliani A, Thoren P. Cardiac mechanoreceptors. Peripheral circulation and organ blood flow. In: Shepherd JT, Abboud FM, eds. Handbook of physiology. Washington DC: American Physiological Society; 1983:497-555.
14. 14 Garcia-Fernandez MA, Torrecilla EG, Roma DS, et al. Left atrial appendage Doppler flow patterns: implications on thrombus formation. Am Heart J 1992;124:955-61.
15. 15 Grimm RA, Stewart WJ, Maloney JD, et al. Impact of electrical cardioversion for atrial fibrillation on left atrial appendage function and spontaneous echo contrast: characterisation by simultaneous transesophageal echocardiography. J Am Coll Cardial 1993;22:1159-66.
16. 16 Jue J, Winslow T, Fazio G, et al. Pulsed Doppler characterization of left atrial appendage flow. J Am Soc Echocardiogr 1993;6:237-14.
17. 17 Mikael Kortz RA, Delemarre HJ, van Dantzig JM, et al. Left atrial appendage blood flow determined by transesophageal echocardiography in healthy subjects. Am J Cardiol 1993;71:976-81.
18. 18 Akosah KO, Funai JT, Porter TR, et al. Left atrial appendage contractile function in atrial fibrillation. Influence of heart rate and cardioversion to sinus rhythm, Chest 1995;107:690-6.
19. 19 The Stroke Prevention in Atrial Fibrillation Investigators, Predictors of thromboembolism in atrial fibrillation: II. Echocardiographic features of patients at risk. Ann Intern Med 1992;116:6-12.
20. 20 Hoit BD, Shao Y, Gabel M. Influence of acutely altered loading conditions on left atrial appendage flow velocities, J Am Coll Cardiol 1994;24:1117-23.
21. 21 Dimond EG, Kittle CF, Voth DW. Extreme hypertrophy of the left atrial appendage. The case of the giant dog ear. Am J Cardiol 1960;5:122-5.
22. 22 Hoit BD, Shao Y, Tsai LM, et al. Altered left atrial compliance after atrial appendectomy. Influence on left atrial and ventricular filling. Circ Res 1993;72:167-75.
23. 23 Hoit BD, Walsh RA. Regional atrial distensibility. Am J Physiol 1992;262:HI 356-60.
24. 24 Bauman RP, Rembert JC, Greenfield JC, Regional atrial blood flow in dogs. Effect of hypertrophy on coronary flow reserve. J Clin Invest 1989;83:1563-9.
25. 25 Davis CA, Rembert JC, Greenfield JC. Compliance of left atrium with and without left atrium appendage. Am J Physiol 1990;259:H 1006-8.
26. 26 Tabata T, Oki T, Yamada H, et al. Roles of left atrial appendage in left atrial reservoir function as evaluated by left atrial appendage clamping during cardiac surgery. Am J Cardiol. 1998;81:327-32.
27. 27 Chapeau C, Gutkowska J, Schiller PW, et al. Localization of immunoreactive synthetic atrial natriuretic: factor (ANF) in the heart of various animal species. J Histochem Cytochem 1985;33:541-50.
28. 28 Kaye GC, Butler MG, D'Ardenne AJ, et al. Identification of immunoreactive atrial natriuretic peptide in atrial amyloid. J Clin Pathol 1986;39:581-2.
29. 29 Linke RP, Voigt C, Strorkel FS, et al. N-terminal amino acid sequence analysis indicates that isolated atrial amyloid is derived from atrial natriuretic peptide, Virchows Arch B Cell Pathol Mol Pathol 1988;:125-7.
30. 30 Kappagoda CT, Linden RJ, Saunders DA The effect on heart rate of distending the atrial appendages in dogs. J Physiol (Land) 1972;225:705-19.
31. 31 Sakomoto I, Hayashi K, Matsunaga N, et al. Coronary angiographic finding of thrombus in the left atrial appendage. Acta Radiol 1996;37:749-53.
32. 32 Manning WJ, Weintraub RM, Waksmonski CA, et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study. Ann Intern, Med 1995;123:817-22.
33. 33 Anderson JL, Acute treatment of atrial fibrillation and flutter. Am J Cardiol 1996;78:17-21.
34. 14 Salka S, Saeian K, Sagar KB. Cerebral thromboembolization after cardioversion of atrial fibrillation in patients without transesophageal echocardiographic findings of left atrial thrombus. Am Heart J 1993;126:722-4.
35. 35 Manning WJ, Silverman DI, Gordon SP, et al. Cardioversion from atrial fibrillation without prolonged anticoagulation with use of transesophageal echocardiography to exclude the presence of atrial thrombi. N Engl J Med 1993;328: 750-5.
36. 36 Black IW, Fatkin D, Sagar KB, et al. Exclusion of atrial thrombus by transesophageal echocardiogrphy does not preclude embolism after cardioversion of atrial fibrillation. A multicenter study. Circulation 1994;89:2509-13.
37. 37 Manning WJ, Siverman DI, Katz SE, et al. Impaired left atrial mechanical function after cardioversion: relation to the duration of atrial fibrillation. J Am Coll Cardiol 1994;23:1535-40.
38. 38 Leung DY, Black IW, Cranney GB, et al. Prognostic implications of left atrial spontaneous echo contrast in nonvalvular atrial fibrillation, J Am Coll Cardiol 1994;24: 755-62.
39. 39 Bikkina M, Alpert MA, Mulekar M, et al. Prevalence of intraatrial thrombus in patients with atrial flutter. Am J Cardiol 1995;76:186-9.
40. 40 Sommerville W, Chambers J. Systemic embolism in mitral stenosis: relation to the size of the left atrial appendix. BMJ 1964;ii:1167-9.
41. 41 Neilson GH, Galea EG, Hossack KF. Thromboembolic complications of mitral valve disease. Aust N Z J Med 1978;8:372-6.
42. 42 Fleming H, Bailey SM. Mitral valve disease, systemic embolism and anticoagulants. Postgrad Med J 1971;47:599-604.
43. 43 Rubin DN, Katz. SE, Riley MF, et al. Evaluation of left atrial appendage anatomy and function in recent-onset atrial fibrillation by transesophageal echocardiography. Am J Cardiol 1996;78:744-78.
44. 44 Kato H, Nakanishi M, Maekawa N, et al. Evaluation of left atrial appendage stasis in patients with atrial fibrillation using transecsophageal echocardiography with an intravenous albumin-contrast agent. Am J Cardiol 1996;78:365-9.
45. 45 Pittzoli M, Febo O, Torbicki A, et al. Left atrial appendage dysfunction: a cause of thrombosis? Evidence by transesophageal echocardiography-Doppler studies, J Am Soc Echocardiogr 1991;4:435-41.
46. 46 Suetsugu M, Matsuzaki M, Toma Y, et al. Detection of mural thrombi and analysis of blood flow velocities in the left atrial appendage using transesophageal two-dimensional echocardiography and pulsed Doppler flowmetry. J Cardiol 1988;18:385-94.
47. 47 Verhorst PM, Kamp O, Visser CA, et al. Left atrial appendage flow velocity assessment using transesophageal echocardiology in nonrheumatic atrial fibrillation and systemic embolism. Am J Cardiol 1993;71;192-6.
48. 48 Li YH, Hwang JJ, Tseng YZ, et al. Clinical significance of fibrillatory wave amplitude. A clue to left atrial appendage function in non-rheumatic atrial fibrillation. Chest 1995; 108:359-63.
49. 49 Santiago D, Warshofsky M, Li Mandri G, et al. Left atrial appendage function and thrombus formation in atrial fibrillation-flutter: a transesophageal echocardiographic study. J Am Coll Cardiol 1994;24;159-64.
50. 50 Wood KA, Eisenberg SJ, Kalman JM, et al. Risk of thromboembolism in chronic atrial flutter. Am J Cardiol 1997;79:1043-7.
51. 51 Leung DY, Davidson PM, Cranney GB, et al. Thromboembolic risks of left atrial thrombus detected by transesophageal echocardiogram. Am J Cardiol 1997;79:626-9.
52. 52 Fatkin D, Kuchar DL, Thorburn CW, et al. Transesophageal echocardiography before and during direct current cardioversion of atrial fibrillation: evidence for "atrial stunning" as a mechanism of thromboembolic complications. J Am Coll Cardiol 1994;23:307-16.
53. 53 Falcone RA, Morady F, Armstrong WF. Transesophageal echocardiographic evaluation of left atrial appendage function and spontaneous contrast formation after chemical or electrical cardioversion of atrial fibrillation. Am J Cardiol 1996;78:435-9.
54. 54 Grimm RA, Leung DY, Black IW, et al. Left atrial appendage "stunning" after spontaneous cardioversion of atrial fibrillation demonstrated by transesophageal Doppler echocardiography. Am Heart 1995;130:174-6.
55. 55 Dodds GA, Wilkinson WE, Greenfield RA, et al. Evaluation of the effect of transthoracic cardioversion from ventricular tachycardia to sinus rhythm on the left atrial mechanical function. Am J Cardiol 1996;78:1116 9.
56. 56 Labovitz AJ, for the STEPS Investigators. Transesophageal echocardiography in patients with unexplained cerebral ischaemia: multicenter findings [abstract]. Circulation 1994;90(suppl 1):21.
57. 57 Vigna C, Russo A, De Rito V, et al. Frequency of the left atrial thrombi by transesophageal echocardiography in idiopathic and in ischemic dilated cardiomyopathy. Am J Cardiol 1992;70:1500 I.
58. 58 Siostrzonek P, Koppensteiner R, Gossinger H, et al. Hemodynamic and hemorrheologic determinants of the left atrial spontaneous echo contrast and thrombus formation in patients with idiopathic dilated cardiomyopathy. Am Heart J 1993;124:430-4.
59. 59 Scardi S, Mazzone C, Pandullo C, et al. Non rheumatic atrial fibrillation and left atrial thrombus formation -relation between left atrial appendage function, clinical and hacmatological findings [abstract], J Am Coll Cardiol 1997; 29(suppl);526A.
60. 60 Petersen P, Boysen G, Godtfredsen J, et al. Placebocontrolled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications of atrial fibrillation. The Copenhagen AFASAK Study. Lancer 1989;i:175-9.
61. 61 Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of anti-thrombotic therapy in atrial fibrillation: analysis of pooled data from five randomised controlled trials. Arch Intern Med 1991;154:1449-57.
62. 62 Albers GW. Atrial fibrillation and stroke: three new studies, three remaining questions. Arch Intern Med 1994;154: 1443-8.
63. 63 Saour JN, Sieck JO, Mamo LA, et al. Trial of different intensities of" anticoagulation in patients with prosthetic, heart valves. N Engl J Med 1990;322:428-32.
64. 64 Jegaden O, Eker A, Delavahe F, et al. Thromboembolic risk and late survival after mitral valve replacement with the St Jude Medical Valve, Ann Thorac Surg 1994;58:1721-8.
65. 65 Gottlieb LK, Salem-Schatz S. Anticoagulation in atrial fibrillation; does efficacy in clinical trials translate into effectiveness in practice? Arch Intern Med 1994;154:1945-53.
66. 66 North America Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445-53.
67. 67 Bailey CP, Olsen AK, Keown KK, et al. Commissurotomy for mitral stenosis: technique for prevention of cerebral complications, JAMA 1952;149:1085-91.
68. 68 Belcher JR, Somerville W. Systemic embolism and left auricular thrombosis in relation to mitral valvotomy, BMJ 1955;ii:1000-3.
69. 69 DiSesa VJ, Tam S, Cohn LH. Ligation of the left atrial appendage using an automatic surgical stapler, Ann Thorac Surg 1988;46:652-3.
70. 70 Benjamin HA, Metzler CH, Peterson TV. Chronic atrial appendectomy alters sodium excretion in conscious monkeys. Am J Physiol 1988;254:R699-705.
71. 71 Stewart JM, Dean R, Brown M, et al. Bilateral atrial appendectomy abolishes increased plasma atrial natriuretic peptide release and blunts sodium and water excretion during volume loading in conscious dogs. Circ Res 1992;70: 724-32.
72. 72 Omari BO, Nelson RJ Robertson JM. Effect of right atrial appendectomy on the release of atrial natriuretic hormone. J Thorac Cardiovasc Surg 1991;102:272-9.